AB0413 STEROID SPARING EFFECT OF JAK-INHIBITORS ACROSS MULTIPLE PATIENTS POPULATION
Authors: P. Conigliaro, C. Minerba, A. Vendola, E. Greco, B. Kroegler, S. Modica, P. Triggianese, M. S. Chimenti, A. Bergamini
Journal: Annals of the Rheumatic Diseases (2022)

Background JAK-inhibitors (JAK-i) represent an effective choice in achievement of therapeutic target in bio-naïve (bnaïve) and bDMARD-insufficient responders (bDMARD-IR) patients. However, oral glucocorticoids (OGC) are commonly used in clinical practice in combination with b/tsDMARDs in Rheumatoid and Psoriatic Arthritis (RA and PsA) patients in order to reach clinical remission. Objectives To assess, in a real-life clinical setting, the reduction of OGC dose during JAK-i treatment in RA and PsA patients that were b-naïve or ≥1-bDMARD-IR or ≥2-bDMARDs-IR with different mechanisms of action. Methods Patients with active RA or PsA treated with first JAKi were prospectively enrolled in a single center. Disease activity (DAS28-CRP or DAPSA), pain visual analogic scale (VAS-pain), general health (GH) and mean prednisone dosage (PDN dose) were collected at baseline and after 4, 8 and 12 months (T4, T8, T12) of treatment. Results 89 patients with active arthritis (77 RA, 12 PsA) were treated with JAK-i (43 patients received Baricitinib, 41 Tofacitinib and 5 Upadacitinib), with all patients reaching T4, 65 patients T8 and 50 patients T12 (Table 1). 27% patients were b-naïve, 73% ≥1-bDMARD-IR and 34% ≥2-bDMARDs-IR. A mean OGC dose of 4.0 ± 4.6 (mg per day) was used and 39% of patients received JAK-i without csDMARDs. We observed a significant improvement of disease activity by DAS28-CRP or DAPSA, VAS-pain and GH at all time points in whole population (respectively p&lt;0.01, p&lt;0.05, p&lt;0.0001, p&lt;0.001), in b-naïve (p&lt;0.03, p&lt;0.001, p&lt;0.001, p&lt;0.0001), in ≥1-bDMARD-IR (p&lt;0.0001 for all the measures at all time points) and in ≥2-bDMARDs-IR (p&lt;0.006 for DAS28-CRP, p&lt;0.0001 for the others) patients. In all the cohort we reported a statistically significant reduction of PDN dose at T4 (p &lt;0.0001), T8 (p=0.02) and T12 (p=0,002). Likewise, b-naïve patients were able to reduce PDN dose at all time points (p=0.01 for all comparisons); ≥1-bDMARD-IR patients were able to significantly reduce PDN dose at T4 (p&lt;0.0001) and T12 (p=0.03); ≥2-bDMARDs-IR ones also spared steroids at all time points (T4 p=0.0004, p=0.02 at T8 and T12). In patients who completed the follow-up withdraw of OGC was observed at T4 in 42% of patients (44% b-naïve, 41% ≥1-bDMARD-IR and 43% ≥2-bDMARDs-IR patients), at T8 in 31% of patients (25% b-naïve, 33% ≥1-bDMARD-IR and 35% ≥2-bDMARDs-IR patients) and at T12 in 40% of patients (67% b-naïve, 32% ≥1-bDMARD-IR and 38% ≥2-bDMARDs-IR patients). Table 1. Women 75% (67) Age (years) 60 ± 12 Seropositive 66% (51) Disease duration (months) 132 ± 88 DAS28 CRP 4.0 ± 1.0 DAPSA 40.6 ± 19.7 VAS-pain 67.7 ± 15.8 GH 68.1 ± 15.2 Conclusion JAK-i administration allows to reduce concomitant OGC regardless of line of b-DMARDs treatment. Chronic OGC may have detrimental bone, metabolic, cardiovascular and infective side effects; therefore JAK-i steroid-sparing effect may be beneficial for patients in long-term treatment. Disclosure of Interests None declared